Giant Basal Cell Carcinoma of the Lateral Neck: A Case Study

A giant basal cell carcinoma (GBCC) is a rare variant of basal cell carcinoma (BCC) that is larger (>5 cm) and more aggressive. While BCC is usually surgically excised as a small, local tumor, cases of GBCC represent a considerable portion of BCC malignancies and mortality. The growth of GBCC is hypothesized to be multifactorial, and due to the successful treatment of BCC, available data is limited. We present a case of GBCC found during routine post-mortem dissection in a 92-year-old male cadaver. The neoplasm showed predilection to periauricular soft tissue invasion, despite demonstrating high-risk characteristics for metastasis. Microscopic analysis demonstrated an infiltrative growth pattern and neurotropism. Perineural spread could be observed on gross dissection, indicating a worse prognosis, but there was no evidence of lymphatic or hematogenous spread. This is most likely due to the stromal dependence of BCC. Local invasion of the primary tumor likely compromised head and neck function, but there was no secondary tumor evidence. There were no histopathological findings that indicate an aggressive growth or metastatic transformation of the tumor. Therefore, while a conclusion about duration cannot be made due to the anonymity of the cadaver, duration of growth likely was a significant factor in mortality.